ANATOMY: LE ​2​ | TRANS​ 2.

03A
Cerebral Cortex and Higher Cortical Functions
IMELDA D. RIVERA, MD, FPSP​. | 09/23/2020

− Temporal
OUTLINE ▪ Synthetic
I. Brain IV. Neuroanatomical Basis − Limbic – composed of ​parahippocampal (base of the
II. White Matter Fibers of Language brain) and the ​cingulate​ (sagittal section) gyrus
A. Commissural Fibers A. Auditory Pathway − Insula/Insular/Central – ​inside the Sylvian/Lateral
B. Association Fibers B. Visual Pathway fissure
C. Projection Fibers V. Disorders of Cortical
III. Gray Matter Networks
A. Subdivisions A. Agnosia
B. Regions B. Apraxia
C. Cells C. Aphasia
D. Layers VI. Cerebral
E. Cortical/Vertical Dominance
Column VII. Review Questions
F. Variations in Cortical VIII. References
Structure
G. Functional Areas
SUMMARY OF ABBREVIATIONS
BA Brodmann Area

📣 📖 📋
Remember Lecturer Book Previous Trans
❗​
LEARNING OBJECTIVES
✔ Relate the anatomical, functional and cytoarchitectural
areas of the cerebral cortex, and its functions, to Figure 2.​ Transverse section of the brain showing the white and gray matters
and nuclei
neurologic clinical manifestations.
✔ Review lobes, gyri, & sulci ● White matter​ – consists of myelinated nerve fibers or axons
✔ Describe the types of fibers comprising the white matter
● Gray matter/Cortex ​– consists of cell bodies
✔ Differentiate the subdivisions & regions of the cerebral
cortex ​ collection of nerve cell bodies (darker stain in Fig. 2)
● Nuclei –
✔ Describe the cells and layers of the cerebral cortex II. WHITE MATTER FIBERS
✔ Identify the anatomic, functional, & cytoarchitectural areas ● White appearance due to ​myelination
✔ Discuss the basis of language ● Supported by neuroglia
✔ Explain cerebral dominance ● Classifications
✔ Differentiate briefly the common disorders of the cerebral → Commissural Fibers
cortex (Aphasia, Agnosia, and Apraxia) ▪ Connections between homologous areas of the two (2)
I. BRAIN hemispheres
▪ “Left and Right”
→ Association Fibers
▪ Connections in the same hemisphere
▪ “Back and Forth”
→ Projection Fibers
▪ Connects the superior and inferior structures
▪ Connect to subcortical nuclei
▪ “Up and Down” or “Superior to Inferior” and vice versa
A. COMMISSURAL FIBERS
● Connections between homologous areas of the left and right
hemispheres
→ “bridges”
→ “Left to Right” and vice versa
● Divided into five (5):
→ Corpus Callosum
→ Anterior Commissure
→ Posterior Commissure
→ Commissure/Crura of the Fornix
Figure 1.​ Lobes of the Cerebrum/Brain from a sagittal view
→ Habenular Commissure
● Cerebrum​ – largest part of the brain
→ 6 lobes Corpus Callosum
▪ Major ● Largest commissure
− Frontal ● Lies beneath the longitudinal fissure
− Parietal
− Occipital

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 Posterior Commissure
● Carries a bundle of ​decussating nerve fibers​ of ​the superior
colliculi and pretectum​ (visual reflex fibers)

Figure 3.​ Superior view of the brain showing the Corpus Callosum

● Four (4) parts:

→ Rostrum ​(can be seen in Figure 4)
▪ Thin part of the anterior end of the corpus callosum ●
▪ Interconnects ​anterior part of the frontal lobe Figure 5.​ Sagittal view of the brain showing the posterior commissure (red
→ Genu ​(can be seen in Figure 4) arrow) and habenular (green arrow)
▪ Interconnects ​anterior part of the frontal lobe ● Inferior lamina or stalk of the pineal gland
→ Body/Trunk ● Plays a role in ​language​ processing
▪ Interconnects ​posterior parts of the frontal lobe​, ​entire
parietal lobe​, and ​superior part of the temporal lobe Commissure/Crura of Fornix
→ Splenium
▪ Interconnects ​occipital lobe
Anterior Commissure

Figure 6.​ Schema of the fornix showing the commissure and crura of the fornix
● Also known as ​Hippocampal Commissure
● Bundle of fibers ​interconnecting the hippocampi of two
cerebral hemispheres
● Myelinated nerve fibers and constitute the efferent system of
the hippocampus, which is part of the limbic system
● Hippocampus ​has both commissural and association fiber
Figure 4.​ Sagittal view of the brain showing the genu and rostrum of the
Corpus Callosum and the Anterior Commissure
● Located in the ​anterior wall of the third ventricle
● Interconnects the ​right and left temporal lobe
● Interconnects the ​inferior and middle temporal gyri
● Above the hypothalamus
● Small bundle of nerve fibers that crosses the midline in the
lamina terminalis
● When traced laterally, it is divided into:
→ Anterior Bundle – curves forward on each side toward the
anterior perforated substance and the ​olfactory tract
→ Posterior Bundle – passes underneath the lentiform
nucleus of the ​basal ganglia

Figure 7.​ Transverse section of the brain showing the fornix in place

ANATOMY Cerebral Cortex and Higher Cortical Functions Page ​2​ of ​14
 ● Fibers that connect various cortical regions within ​the same
hemisphere
→ “Back and Forth”
● Divided into short and long fibers
Short Association Fibers
● Arcuate Loops/Fibers
→ Lie immediately beneath the cortex
→ Connects two adjacent gyri
→ Runs transversely along the long section of the sulci

Figure 8.​ Superior view of the brain showing the schema of the fornix
Habenular Commissure

Figure 11.​ Major association bundles on a sagittal section

Long Association Fibers
● Superior Longitudinal Fasciculus
→ Largest bundle of fibers
→ Located ​above the insula
→ Connects the ​frontal, parietal, and occipital lobes
→ Gives rise to the ​Arcuate Fasciculus
▪ Located ​posterior to the insula
▪ Arches from the ​superior longitudinal into the temporal
lobe
▪ Connects​ frontal and temporal lobes
Figure 9.​ Median sagittal section of the brain showing the habenular ▪ Plays a role in language development’
commissure just above the pineal gland ● Inferior Occipitofrontal Fasciculus
● Can be seen in figures 5 and 9 → Runs anteriorly from the occipital lobe, passing lateral to
● Consists of ​stria medullaris fibers​ crossing over to the the optic radiation and is distributed to the temporal lobe
contralateral habenular nuclei → Located ​below the insula
● Superior lamina or stalk of the pineal gland → Connects ​frontal, temporal, and occipital lobes
● Connects the ​Habenular nuclei ​of the two cerebral ● Uncinate Fasciculus
hemispheres → Connects the ​first motor speech area and the gyri on the
→ Receive afferent fibers from the amygdaloid nuclei and the inferior surface/orbital part of the ​frontal lobe and the
hippocampus temporal lobe
→ Fibers pass to the habenular nuclei in the ​stria medullaris ● Cingulum
thalami → Located beneath the ​cingulate gyrus ​and
→ Some of the fibers cross the midline to reach the parahippocampal gyrus ​(forming part of the limbic
contralateral nucleus through the habenular commissure system)
→ Connects the frontal and parietal lobes with the
B. ASSOCIATION FIBERS
parahippocampal and adjacent temporal regions
C. PROJECTION FIBERS

Figure 10.​ Major association fibers of the left hemisphere on a sagittal section Figure 12.​ Lateral view of the sagittal section of the right hemisphere

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 ● Afferent and efferent “tracts”
● Most of the projection fibers lie medial to the association fibers
and intersect the commissural fibers of the corpus callosum
and the anterior commissure
● Types:
→ Internal Capsule
→ External Capsule
→ Corona Radiata
→ Optic Radiations

Figure 13.​ Medial view of the right hemisphere

Internal Capsule
● Largest
● Compact band of afferent and efferent fibers that are formed
at the upper part of the brainstem
● Flanked ​medially by the ​caudate nucleus​, ​laterally ​by the
lentiform nucleus
● Median to the anterior limb are the ​caudate nuclei
● Median to posterior limb is the ​thalamus
● Parts:
→ Bent to form an ​anterior limb and a ​posterior limb which Figure 15.​ A) Superior view and B) Inferior view of the internal capsule
are continuous with each other at the ​genu ​at the level of External Capsule
the interventricular foramen ● Lateral to lentiform nuclei & contains ​cholinergic fibers
→ Descending fibers​ pass through the ​posterior limb ● Separated from the subcortical matter of the insula by the
→ Ascending fibers​ make up the ​anterior limb claustrum
● Associated tracts ● Separates the lentiform nucleus from the claustrum, a sheet of
→ Genu: ​Corticobulbar tract gray matter
→ Posterior limb: ​Corticospinal tract
→ Anterior limb: ​Thalamocortical tract

Figure 16.​ Lateral view of a sagittal section exposing the external capsule
Corona Radiata
● Nerve fibers that radiate in all directions to the cerebral cortex
● Same fibers with the internal capsule, but have different
names at different levels:
→ At the level of lentiform nuclei: projection fibers called
internal capsule
→ Superiorly to lentiform nuclei: fibers are called the ​corona
radiata
Figure 14.​ Superior view of the transverse section of the right hemisphere

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 B. REGIONS
● Isocortex
→ “Prototype cortex”
→ Consists of ​all six layers (discussed further in Section III.
D.)
● Mesocortex
→ Layers vary in number (3-6 layers)
→ Found in the paralimbic areas
▪ Medial and basal parts of the cerebral hemisphere
● Allocortex
→ Composed of 3 layers
→ Corresponds to limbic system ​[2023A Trans]
→ Usually in the hippocampal formation and piriform cortex
Figure 17.​ Lateral view of a sagittal section exposing the corona radiata.
Optic Radiations
● Corticoid Areas
→ “Cortex-like” – same traits and functions with cortex ​
▪ Also have neurochemical traits and neuronal
📣
connections
▪ But has ​no distinct layers​ of cells
→ Found in the septal region, substantia innominata, parts of
the amygdaloid complex

C. CELLS OF CEREBRAL CORTEX

Figure 18.​ Optic radiation

● Continuation of the internal capsule posteriorly radiating
to the visual cortex of the occipital lobe
● Nerve fibers that lie ​within the most posterior part of the
posterior limb of the internal capsule
● Radiate toward the ​calcarine sulcus

Figure 20. ​Cells of the Cerebral Cortex ​📣

1. Pyramidal Cells
● “Pyramidal” – shape of their cell bodies
● Largest​ among the five cells
→ Only definite/recognizable cell in a histologic section
▪ Even the layers are not distinct from one another ​ 📣
● Multipolar, efferent neurons
Figure 19.​ Superior view of a transverse section showing the optic radiation ● Found in Layers 3 and 5
● Betz cell
III. GRAY MATTER
→ Largest pyramidal cell
A. SUBDIVISIONS → Found in layer 5
● Neocortex ▪ In the motor precentral gyrus of the frontal lobe
→ “Neo” – new
→ Last to develop/youngest part of the brain
→ Comprises majority (90%) of the cortex (majority of the
📖
→ Account for ~3% of the projection fibers of the
corticospinal/pyramidal tract ​ ​ [Snell,
● Structure and Orientation:
​ 2019]

functional areas) → Apical dendrites

● Paleocortex ▪ Large and contains dendritic spines
→ Developed before the neocortex ▪ From the apex of the cell body

📋📣
→ Restricted to the base of the brain
→ Includes the piriform lobe ​ ​ [2021B Trans]
▪ “Primary olfactory cortex” ​ ​ – for olfaction
▪ Extends upward toward the pial surface
→ Basal dendrites
▪ Several, large
● Archicortex ▪ Pass horizontally
→ “Archi” – archaeologic → Axon
→ Earliest to develop/oldest part of the cortex
→ Makes up the hippocampal formation
→ Function for memory, emotions
📖
▪ From the base of the cell body
▪ 2 Possibilities:​ ​ ​ [Snell,
​ 2019]

− Terminates in the deeper cortical layer

− Enters subcortical nuclei of the white matter of
*Limbic System: comprised of the paleocortex and archicortex the cerebral hemisphere as either of these 3
types:
o Association – terminate in the same
hemisphere, but another region

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 o Commissural – terminate in the cortex of
the opposite hemisphere D. LAYERS OF CEREBRAL CORTEX
o Projection – reach subcortical nuclei (unlike
association and commissural)
2. Stellate/ Granule Cells
📖
● “Granule” – small size, polygonal shape ​ ​ ​[Snell, 2019]
● Most numerous​ among the five
● Sensory interneurons
● Found in Layers 2 and 4
→ In the sensory and association areas
● Structure:
→ Dendrites
▪ Several, short, branching
▪ Extend in all directions
→ Axon
▪ One, short
▪ Arborizes/terminates on a nearby neuron ​
3. Fusiform Cells
📣
● Vertically-oriented, interconnecting cell
● Multipolar neurons
● Found in Layer 6
● Structure:
→ Dendrites
▪ From each pole of the cell body
▪ Arranged perpendicularly in each pole
▪ Inferior Dendrite
− Branches within same layer
▪ Superficial Dendrite
− Ascends toward the surface of the cortex
− Branches at the superficial layers
→ Axon
▪ From the inferior pole
Figure 22. ​Layers of the Cerebral Cortex ​📣
📖
▪ Enters white matter as either of these 3
types:​ ​ ​ [Snell,
​
− Projection fiber
2019] 1. Layer 1: Molecular/Plexiform Layer
● Most superficial layer
● Adjacent to pia mater
− Association fiber
● Least number of cells
− Commissural fiber
4. Horizontal Cells of Cajal
● Small, fusiform, horizontally-oriented
📖
● Site where several synapses between different neurons
occur ​ ​ [Snell,
● Contains:
​ 2019]

● Multipolar neuron
● For association of neurons within the same layer → Dense network of horizontally-oriented nerve fibers
● Found in Layer 1 ▪ Associate with fibers within the same hemisphere
● Structure: → Afferent fibers that originate from the thalamus and in
→ Dendrites association with commissural fibers
▪ Arise from each end → Horizontal cells of Cajal
→ Axon 2. Layer 2: External Granular Layer
▪ Runs parallel along the surface of the cortex
▪ Synapse with pyramidal cell dendrites
● Contains:

→ Stellate cells
📋
→ Pyramidal cells ​ [2023A
​ Trans]

5. Cells of Martinotti
● Small, multipolar neurons 3. Layer 3: External Pyramidal Layer
● For association of cells within the cortex ● Send association fibers
● Found in ​all layers ● Contains:
● Structure: → Pyramidal cells
→ Short dendrites
→ Axon
4. Layer 4: Internal Granular Layer
​ 📖
▪ Size of cell body increases from the superficial part
of the layer to the deeper parts ​ ​ [Snell, 2019]

▪ Directed towards pial surface of the cortex

▪ Terminates usually at Layer 1 ● Contains:
▪ Serve as origin to a few short collateral branches → Closely-packed stellate cells
5. Layer 5: Internal Pyramidal/Ganglionic Layer
● Contains:
→ Bertz cells
→ Stellate cells
6. Layer 6: Multiform Layer/Layer of Polymorphic Cells
● Contains:
→ All types of cells
▪ Majority are ​fusiform
→ Cells of Martinotti
▪ Conspicuous in this layer

Figure 21. ​Cells of Martinotti (M) and Pyramidal cells (P) ​📣

ANATOMY Cerebral Cortex and Higher Cortical Functions Page ​6​ of ​14
 F. VARIATIONS IN CORTICAL STRUCTURE
● Not all areas of the cerebral cortex possess 6 layers
→ Depend on the thickness of the layer
● Homotypical
→ Prototype pattern of 6 well-developed layers of cells ​
→ In the middle is a homotypic cortex
📣
▪ Usually association areas
→ Most of the cortex
● Heterotypical/Idiotypic
→ Areas of the cortex where the 6 layers aren’t that distinct
→ Have extreme variations – 1 or 2 layers may predominate
→ Types:
1. Granular type
− Well-developed granular layers (Layers 2 and 4)
o Layers 3 and 5 are poorly developed
Figure 23.​ Direction and interconnections of fibers with the layers ​ 📣 o Layers 2 – 5 are not identifiable from one another
= Merge into one layer of granular cells
− Contain densely packed ​stellate cells
− Receive thalamocortical fibers – mainly sensory
− Found in the postcentral gyrus, superior temporal
gyrus, and in parts of hippocampal gyrus ​
2. Agranular Type
📣
📋
− Poorly developed granular layers (practically no
Layers 2 and 4) ​ ​ [2021B Trans]
− Contain densely packed large pyramidal cells
and well developed Layers 3 and 5
− Give rise to several efferent fibers with motor
functions
− Found in the precentral gyrus and other areas in
the frontal lobe

Figure 24.​ Summary of the layers of the cerebral cortex ​ 📋​ [2021B Trans]

E. CORTICAL/VERTICAL COLUMN
● Functional unit of the cortex
→ Cortex is arranged into vertical units/columns

📋
▪ True for all six cortical layers
▪ Cannot be delineated ​ ​ [2023A Trans]
▪ Has projection fibers that connects one layer to another
● Organized in groups of neurons
● Oriented perpendicular to the surface
● Allows the person to process the information/stimulus/modality
● Each column/unit:
📖
→ does one specific function ​ ​ [Snell,
​ 2019]

▪ If in the sensory portion, one specific sensory function

→ Contains:
▪ Thousands of neurons

📖
− interconnected in the vertical direction
▪ Afferent fibers ​ ​ [Snell,
​ 2019]

− Could either synapse directly with an efferent neuron

or recruit vertical columns of internuncial neurons Figure 26. ​Comparison of the Sensory, Association, and Motor Cortex
→ In Figure 26, the association cortex in the middle has a

uniform distribution of layers ​ 📣

homotypic pattern, with well-developed and relatively

▪ The motor cortex in the right have enlarged Layers 3

and 5 while Layers 2 and 4 are reduced
▪ The sensory cortex in the left have enlarged Layers 2 –
4 while Layer 5 is reduced

● Brodmann Areas (BA) ​ 📣

G. FUNCTIONAL CORTICAL AND BRODMANN AREAS

→ By Korbinian Brodmann (1898-1918), a German anatomist

→ 47 different areas of the cerebral cortex
▪ Grouped according to their histological cellular
components – ​cytoarchitecture
→ Named in the order by which they were studied
→ Found to be related to the functional cortical areas

Figure 25​. Neuronal Connection of the Cerebral Cortex ​ 📣

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 Functional Cortical Areas (Classification According to Table 1.​ Important Brodmann and Functional Areas ​📣❗
Modality) Brodmann Location/
Functional Area
● Primary Areas Area Anatomical Name
→ Receive​ stimulus/modality Primary
→ First area where stimulus will be processed in the cortex 3,1,2 Somatosensory/ Postcentral Gyrus
▪ Later sent to association areas Somesthetic
→ Examples: 4 Primary Motor Precentral Gyrus
▪ Primary visual area in the lips of calcarine fissure Somesthetic Superior Parietal
5,7
− Color, shape, size, texture Association Lobule
▪ Primary auditory in the transverse temporal gyrus Anterior Precentral
▪ Primary sensory area in the postcentral gyrus Premotor/ Secondary Gyrus, posterior parts
6, 8
▪ Primary motor area in the precentral gyrus Motor of Superior, Middle, &
→ Has ​idiotypic isocortex ​(layers depend on the location) Inferior gyri
● Association Areas Lips of Calcarine
→ Adjacent/surrounds the primary areas 17 Primary Visual
Fissure
→ Most external surface of the cortex Area around Primary
→ It ​interprets​ the data/stimulus received 18,19 Secondary Visual
Visual Cortex
→ Has ​homotypical isocortex ​(all six layers are equal) Middle and Inferior
→ Two types: 20,21,37 Visual Association
Temporal Gyri
1. Unimodal Posterior part of
▪ Usually lies adjacent to primary areas Auditory Association/
22 Superior Temporal
▪ Receives and processes only 1 type of modality Wernicke’s Area
Gyrus
− i.e. visual association area for visual sensation Medial Temporal
only 28, 34 Entorhinal
Gyrus
▪ Examples – visual, auditory, somatosensory
Base of Frontal Lobe
association, and motor association areas
34 Primary Olfactory and Medial Temporal
2. Heteromodal
Lobe
▪ Receives different kinds of modality at the same time
Anterior Transverse
− Leads to activation of a single group of neurons 41 Primary Auditory
Temporal Gyrus
▪ Prefrontal Cortex
Posterior Transverse
📋
− Largest part of the frontal lobe and located rostral
to the motor areas ​ ​ [2023A Trans]
− Integrate motivational events with complex
42
39
Secondary Auditory
Temporal Gyrus
Angular Gyrus
Gustatory/Taste Center
sensory stimuli 43 Postcentral Gyrus
− Processing site of attention, behavior, judgment, Inferior Frontal Gyrus
Motor Speech/

📣
and decision-making 44, 45 (Opercular and
Broca’s Area
− If there is a lesion in this area, patient may be: ​ Triangular portion)
o Unconcerned with illness & appear depressed
o Ignore ordinary standards of cleanliness, like
eating from the floor
o Essentially having no insight
▪ Temporoparietal Association Area
− Includes both lateral and medial surfaces of the
posterior parietal cortex
− On the medial side, it continues into the posterior
part of the temporal lobe
− Extends from the middle and caudal superior
temporal gyri into the inferior parietal lobule and
the posterior part of the superior parietal lobe
− Examples
o Auditory cortex of the lateral temporal lobe
o Somatosensory cortex of the anterior parietal
lobe
o Visual cortex of the occipital lobe
o Paralimbic cortices on the medial surface of
the hemisphere
− Wernicke’s Area
o Part of the temporoparietal association area
= Specifically, in the posterior part of the
superior temporal gyrus or BA 22
o Important in ​language formation

Figure 27. ​Brodmann’s Area ​ 📣

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 Figure 28. ​Lateral view of the right cerebral hemisphere ​ 📣
Figure 31.​ Probable nerve pathways involved with hearing a question and
answering it​ [Snell,
​ 2010]

● Steps of Language Formation via Auditory Pathway​:

📖
1. Auditory input is received in the ​spiral ganglion in the ear
through the ​medial geniculate body ​ ​. ​[Snell, 2010]
2. The spiral ganglion will send projection fibers to the
Primary Auditory Area​ (BA 41 and BA 42).
▪ Location​: inferior wall of the lateral sulcus
​
▪ Function [Snell, 2010]​
:
− Anterior part: For reception of LOW frequency sounds
− Posterior part: For reception of HIGH frequency
sounds
▪ BA 41 - a granular type of cortex
▪ BA 42 – homotypical, mainly an auditory association
area
3. After processing, the information will be sent to the
Secondary Auditory Area ​(BA 22).
▪ Location​: posterior to the Primary Auditory Area in the
lateral sulcus and in the superior temporal gyrus.
Figure 29. ​Medial view of the right cerebral hemisphere ​📣 ▪ Function​: Interpretation of sounds for the ​association of
​
the auditory input with other sensory information​. [Snell, 2010]

IV. NEUROANATOMICAL BASIS OF LANGUAGE 4. Information via association fibers will be sent to ​Wernicke’s
● Language is learned through ​two pathways​, either by Area​ (BA 22) for analysis and interpretation.
auditory​ or ​visual​. ▪ Location​: localized in the left dominant hemisphere,
mainly in the superior temporal gyrus, with extensions
around the posterior end of the lateral sulcus into the
parietal region
▪ Arcuate fasciculus – bundle of nerve fibers that
connects Wernicke’s Area to Broca’s Area
▪ ​Function​: Allows ​understanding of the written and
spoken language [Snell] ​
− Allows a person to read a sentence, understand it,
and speak it out loud
▪ Site in the cerebral cortex ​where somatic, visual, and
📖
auditory association areas all come together ​ ​. [Snell]
​
5. After interpretation, association fibers will be sent to
Broca’s Area​ (BA 44 and BA 45).
▪ Location​: inferior frontal gyrus between the anterior and
ascending rami and the ascending and posterior rami of
the lateral fissure

muscles concerned with voice production ​ 📣

▪ Function​: “Like an architect” -- design the movement of

▪ Without Broca’s Area, output will be very slow because

Figure 30.​ Summary of the Sensory Anatomical Connections of the Cerebral
Cortex [Snell,
​ 2010]

produce sound ​ 📣
of loss of instruction and loss of design on how to

6. The instruction will be sent to the ​Primary Motor Area​.

A. AUDITORY PATHWAY 7. Projection fibers will be sent to ​organs involved in
● Receptor​: Organ of Corti in the ear sound/language production (i.e. larynx, tongue, movement
of the mouth).

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 B. VISUAL PATHWAY ● E: ​Execution – Primary Motor Area
● D: ​Design
*Note: For visual pathway​, information will ​be sent first ​to
Angular Gyrus ​before going to​ Wernicke’s Area.
V. DISORDERS OF THE CORTICAL NETWORK
● Lesion in the CORTEX ONLY. Tracts and other nuclei
structures are intact.
A. AGNOSIA
● “a” – without, “gnosia” – knowing, to know
● Failure to recognize stimuli when the appropriate sensory
systems function adequately
● There are several types of agnosia depending on where the
lesion is found.
Types of Agnosia
● Visual Agnosia
→ Failure to recognize objects ​visually in the absence of a
defect of visual acuity or intellectual impairment
→ Intact visual acuity but still unable to recognize objects
→ Lesion​: ​temporal aspect of visual unimodal association
areas
Figure 32.​ Probable nerve pathways involved in reading a sentence and ▪ “You see the object (a pen), but you cannot name it due
​
repeating it out loud​ [Snell, 2010]
to a lesion in the cerebral cortex. If you don’t see the
● Receptor​: Rods and Cones in the eyes object and just touch it (if tactile is intact), you can name
● Steps of Language Formation via Visual Pathway​: the object.”
1. Visual input is received in the retina through the lateral ● Tactile Agnosia
geniculate body.​ [Snell, 2010] → Inability to recognize objects by ​touch when tactile and
2. The retina will send projection fibers to the ​Primary Visual proprioceptive sensibilities remain intact in the part of the
Area​ (BA 17). body being tested.
▪ The Primary Visual Area is located in the walls of the → Lesion:​ ​supramarginal gyrus (BA 40)
posterior part of the calcarine sulcus and occasionally ▪ When you hold an object, you cannot properly identify it.
extends around the occipital lobe onto the lateral surface But when you try to look at it you will be able to name
of the hemisphere. the object.
▪ Macroscopically: thin cortex and visual stria ● Auditory Agnosia
▪ Microscopically: granular type of cortex, only few → Failure to recognize ​specific sounds​, including speech,
pyramidal cells are present music or familiar noise despite having intact hearing
3. After processing, information will be sent to the ​Secondary → Lesion: ​posterior part of the superior temporal gyrus (BA
Visual Area​ (BA 18 and BA 19). 22)
▪ The Secondary Visual Area surrounds the Primary
Visual Area on the medial and lateral surfaces of the B. APRAXIA
hemisphere ● Loss of the ability to correctly carry out certain
▪ Function​: Relate the visual information to ​past visual movements in response to stimuli that normally elicits these
experiences​[Snell, 2010] movements
− Enables the individual to recognize and appreciate ● Results from ​lesions interrupting connections between the
what he/she is seeing
4. After interpretation, association fibers will be sent to the 📋
site of formulation of a motor act and the motor areas
responsible for its execution​. ​ [2023A]
​
📋
● Lesions in the motor areas: not the same as paralysis ​ [2023A]
​
Angular Gyrus​ (BA 39) located in the inferior parietal lobule.
▪ Function​: important in reading
▪ Lesions​: lead to ​alexia (inability to read) and ​dyslexia
(difficulty to read)
📋
● You can move or do anything, but you cannot do commands
intentionally when asked. ​ ​[2023A]
→ Example: Stand up and walk. You cannot walk, but later
− will not be able to interpret written language after the lecture, you unconsciously stand up and walk.
5. Information will be sent to ​Wernicke’s Area ​(BA 22) for
analysis and interpretation.
6. After processing, it will be sent to ​Broca’s Area (BA 44
📋
● Action can be done without awareness. When with conscious
effort cannot do the same action. ​ ​[2023A]
Types of Apraxia
and BA 45), which will orchestrate the design or instruction
● Ideomotor Apraxia
for muscle movement.
7. Information will be sent to the ​Primary Motor Area​. → Inability to perform a ​complex motor task despite
8. Projection fibers will be sent to ​organs involved in awareness of the task that is intended to be performed
sound/language production (i.e. larynx, tongue, → Lesion:​ ​supramarginal gyrus of dominant side of the brain
movement of the jaw). ▪ Patient can perform many complex acts automatically
but cannot carry out the same acts on command

📋
Brodmann Area 22 − Patient can do an activity spontaneously (MOTOR),
● Associated with Wernicke’s Area AND Secondary Auditory but cannot do it upon instruction (IDEA) ​ [2023A]
​
Area ● Ideational Apraxia
● Used in processing/comprehension of sounds heard in → Failure in carrying out ​sequences of acts​, although
language production individual movements can be made correctly
📋
MNEMONIC: RIPPED ​ ​[2021B]
● R: ​Receive – Primary (Auditory/Visual) Area
→ Lesion: ​dominant parietal lobe, corpus callosum
▪ Example​: ​Several instructions: “Stand up, walk, and pick
● I: ​Interpret – Secondary (Auditory/Visual) Area* up the trash” – patient will NOT be able to follow ALL
● P: ​Process – Wernicke’s Area* instructions (multi-step), but a single one-step instruction
● P: ​Program of Movement/Design – Broca’s Area can be done.

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 ● Motor/Kinetic Apraxia → The patient understands and the patient can have output
→ Inability to execute ​fine acquired movements (normal output, not slow), causing frustration and repetition
→ Lesion: ​contralateral frontal lobe of response until correct.
● Gait Apraxia ▪ Example: “How old are you?” The patient answers “25”
→ Difficulty ​initiating and continuing to smoothly carry out but he is not 25, he is only 21 so he will try to correct this
the movements needed for walking until he says the right answer. He will continue to say
→ Lesion​: ​bilateral frontal lobes different ages until he arrives at his correct age.
→ Patients appears to have the feet “glued to the floor,” where ● Global Aphasia
there is a series of incomplete walking movements, then → Massive damage​ of ​dominant part of the brain
patient may stride for one or two steps, only to develop
another series of incomplete ambulatory movement ​ [2023A]
​ 📋 → Damage affects ​Broca’s and Wernicke’s area, arcuate
fasciculus, angular gyrus
→ The motor area may also be affected
C. APHASIA → Encompass the opercular area
● Disorder of ​language caused by a ​defect in either the → No output, no understanding
production​ or the ​comprehension​ of vocabulary or syntax
● Disorder in the processing or expressing of language VI. CEREBRAL DOMINANCE
● Three regions of the dominant cerebral hemisphere that have
important roles in Aphasia:
→ Broca’s Area (BA 44, 45)
→ Wernicke’s Area (BA 22)
→ Intervening Area of Parietal Lobe​ (parietal operculum)
Types of Aphasia
● Motor Aphasia
→ A.k.a. ​Broca’s/Expressive/Nonfluent/Anterior Aphasia
→ Manifestation:
▪ Slow and effortful spoken language with poorly
produced sounds
▪ Ungrammatical​, telegraphic speech where the patient ​ erebral Dominance ​[Lecturer’s PPT]
Figure 33​.​ C
deletes many prepositions, nouns and verbs. ● Anatomically​, the cerebral hemispheres are almost ​identical
▪ Usually accompanied by right hemiplegia → Cortical fissure and gyri of both hemispheres are almost
→ Lesion​: ​Broca’s Area (BA 44, 45) identical
▪ Example: Ask someone with Broca’s Aphasia, “How old → Nervous pathways projecting in the cortex correspond to
are you?” The patient knows/understands the question identical areas
and knows the answer to the question but has difficulty → Cerebral commissures mainly the anterior commissure and
saying it out loud immediately. *long pause* corpus callosum, allow for equal information transfer
“twenty—twen—twenty… twenty-one” eventually the between hemispheres.
patient will be able to say it. ● However, ​nervous activities​ are usually ​different
▪ Broca’s area is not intact but the motor is: if you ask, → Dominant hemisphere controls​: language, speech,
“how old are you?” the patient is able to write it behavior, analytical thinking, calculating, verbalization
instantaneously. handedness
● Speech Sensory Aphasia → Non-dominant hemisphere controls: spatial perception,
→ A.k.a. ​Wernicke’s/Fluent/Receptive/Posterior Aphasia recognition of faces, and music
→ Manifestation:​ a lot of verbal output but no meaning
▪ Rapid production of words with ​preserved grammatical Development of Cerebral Dominance
construction: cannot find the correct words to express ● Cerebral dominance​: depends on which hemisphere
thoughts language is developed
▪ Verbal Paraphasia → Language only develops in one hemisphere​: EITHER
− substitution of one word for another the left or right hemisphere
− Patient uses meaningless words and substitutions → In most studies, more than 90% of individuals are left
▪ Patient does not recognize speech difficulty (poor hemisphere dominant, thus language is more or less
awareness) mostly developed in the LEFT hemisphere of the brain.
▪ Usually no hemiplegia ▪ 96% of the human population has speech production
▪ No interpretation and no understanding but there is and understanding to be left hemisphere dominant
output → Language becomes fully developed on one side at age 10
→ Lesion​: ​Wernicke’s Area (BA 22)
▪ Example: ​Please repeat after me, “fork” the patient will
answer something else (not the word being asked of)
● Handedness
→ Said to depend on the dominant hemisphere ​ ​ [Snell]
→ Left hemisphere dominant
​ 📖
▪ Example: “What did you eat this morning?” Patient will ▪ 95% of right handed
answer, “I went to the zoo, planted rice, went to the ▪ 75% of left handed

📋
moon and studied there.” There is no meaning, jumble → Most of the ​left handed individuals are ​LEFT hemisphere
words. ​ [2023A]
​ dominant, ​but 95% of right-handed are left hemisphere
● Conduction Aphasia dominant also.
→ Disconnection of speech recognition area from speech ▪ Thus, handedness does not depend on cerebral
execution area dominance.
→ Manifestation: → Anatomic Reason: The number of fibers that decussate
▪ Similar manifestation as speech sensory aphasia​, from the L hemisphere going to the R side of the body is
but with ​poor repetition of spoken language greater than the number of fibers that cross from the R
▪ The patient is able to understand but unable to respond hemisphere to the L side of the body at the level of the
correctly medullary pyramids
→ Lesion: ​Arcuate Fasciculus (thus, no conduction pathway ▪ Leading to more control of the R than the L side of the
from Wernicke’s area to the Broca’s area) body

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 ● Hemisphere dominance is only set after the first decade of life
(at age 10)
→ Both hemispheres of a newborn have EQUIPOTENTIAL
capabilities.
→ A 5-year-old child with damage to the dominant
hemisphere can easily learn to use the other hand and
speak well, whereas in the adult this is almost impossible.
● Left hemisphere​: logical thinking and calculation
● Right hemisphere​: creativity and arts
VII. REVIEW QUESTIONS
1. This type of white matter fiber lies superiorly and inferiorly
to the insular lobe.
a. Long association fibers
b. Short association fibers
c. Superior longitudinal fasciculus
d. Inferior longitudinal fasciculus
2. What is the other functional name of Broca’s Area?
a. Primary Auditory Cortex
b. Secondary Visual Cortex
c. Premotor Cortex
d. Motor Speech Cortex
3. In what layer can Bertz Cells be found?
a. Layer 2
b. Multiform Layer
c. External Pyramidal Layer
d. Layer 5
4. It is a vertically-oriented, interconnecting cell that is
mostly located in the deepest cortical layer.
a. Granule cells
b. Fusiform cells
c. Pyramid cells
d. Horizontal cells of Cajal
5. This structure orchestrates the design or instruction for
muscle movement.
a. Wernicke’s Area
b. Broca’s Area
c. Angular Gyrus
d. Premotor Cortex
6. Site in the cerebral cortex where somatic, visual, and
auditory association areas all come together.
a. Cingulate Gyrus
b. Rostrum
c. Wernicke’s Area
d. Arcuate Fasciculus
7. It is a disorder of language where the patient produces
slow and ungrammatical, telegraphic speech.
a. Motor Aphasia
b. Speech Sensory Aphasia
c. Conduction Aphasia
d. Global Aphasia
ANS: 1A, 2D, 3D, 4B, 5B, 6C, 7A

FORMATIVE QUIZ
1. Most of the left handed individuals are (left, right)
hemisphere dominant.
2. The secondary visual cortex is a (heteromodal,
unimodal) association area
3. The long axis of (fusiform, horizontal) cells is
perpendicular to the cerebral cortical surface.
4. The cingulum is composed of (association,
commissural, projection) fibers.
5. The motor speech area is located in the (inferior frontal,
superior temporal, angular) gyrus.
ANS: 1 LEFT 2 UNIMODAL 3 FUSIFORM 4 ASSOCIATION 5 INFERIOR FRONTAL

VIII. REFERENCES
Netter F.H. (2019). ​Atlas of Human Anatomy (7th ​ ​ edition). E
​ lsevier Inc.
Snell R.S. (2010). ​Clinical Neuroanatomy (7​th​ edition). ​Wolters Kluwer.
Snell R.S. (2019). ​Clinical Neuroanatomy (8​th​ edition). ​Wolters Kluwer.
TRANS 2023A
TRANS 2021B

ANATOMY Cerebral Cortex and Higher Cortical Functions Page ​12​ of ​14
 APPENDIX

Table 1.​ Summary of the Association Pathways [2023A]

​

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 Table 2. ​Localization of Structures in the Cerebral Cortex​ [Lecturer’s
​ PPT] &​ [2023A]
​
Lobe Structure Function Destructive Lesion
Contralateral paralysis and paresis (most pronounced in the distal
Area 4 Discrete volitional movements
parts of limb)
Area 8 Conjugate eye movements Transitory paralysis of conjugate eye movements to opposite side
Areas 44,45 (Broca’s
Language production Non-​fluent aphasia
Area)
Frontal Dorsolateral prefrontal Motivation, problem solving, Bilateral lesions: impaired ability to concentrate, easily
cortex judgment distracted, loss of initiative, apathy, cannot make decisions
Orbitofrontal prefrontal Unstable emotions: unpredictable and frequent
Emotions, behavior
cortex unacceptable behavior
Orbital gyri of prefrontal
Olfaction Inability to discriminate odors
cortex (posterolateral part)
Loss of contralateral stimulus location and intensity;
Area 3,1,2 Somesthetic sensations
severe impairment of two-​point and limb position sense
Area 43 Taste Impairment of taste in contralateral side of tongue
Parietal
Processing of somatic and visual
Superior and inferior Tactile and visual agnosia, visual disorientation, neglect
information especially related to
parietal lobes of contralateral self and surroundings
use of hands
Subtle decrease in hearing and ability to localize sounds,
Area 41 Hearing
both contralaterally
Language understanding and
Area 22 (Wernicke’s Area) Fluent aphasia
formulation
Middle inferior and
Storage of auditorically presented
Temporal occipitotemporal gyri Impairment of learning and memory
information
(dominant side)
Temporal cortex Storage of visually presented
Impairment of learning and memory
(nondominant side) information
Bilateral lesion; profound memory loss of recent events
Parahippocampal region Recent memory
and no new learning
Area 17 Vision Contralateral homonymous hemianopsia
Bilateral lesions: color agnosia and loss of spatial relationships
Occipital Areas 18-​19 (parastriate
Visual association (ex. Can’t draw a floor plan of home,
and peristriate)
map of route to work/church, etc.)

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